腹腔镜抗反流手术在基层医院的应用*

摘要： 研究腹腔镜胃底折叠术联合食管裂孔疝（HH）修补术治疗胃食管反流病（GERD）合并HH在基层医院应用的安全性和临床疗效。方法 回顾性分析2016年1月－2018年1月共56例行腹腔镜胃底折叠术联合HH修补术治疗的GERD合并HH患者的临床资料。结果 手术均获成功，无中转剖腹，手术时间56～180 min，平均（68.4±3.6）min，术中出血量30～200 ml，平均（40.3±5.6）ml，无严重并发症及死亡。所有患者术后密切随访6～24个月；术后半年GERD-Q量表评分和De Meester评分较术前均明显降低（P <0.05），食管下括约肌（LES）静息压较术前明显升高（P <0.05）；术后1或2年随访48例患者临床症状完全消失、6例症状明显减轻、2例无效，上消化道X线钡餐检查无HH复发及消化道梗阻。在基层医院，腹腔镜胃底折叠术联合HH修补术治疗GERD合并HH是安全有效的，临床疗效满意。
Abstract: To study the safety and efficacy of laparoscopic fundoplication and hiatal hernia repair for the gastroesophageal reflux disease with hiatal hernia in the primary hospitals. Methods Clinical data of 56 patients underwent laparoscopic fundoplication and hiatal hernia repair was analyzed retrospectively from January 2016 to January 2018. Results The operations were successfully performed in all the patients and no conversion to open surgery, the operation time ranged from 56 ~ 180 min, with an average (68.4 ± 3.6) min, and bleeding from 30 ~ 200 ml, the average was (40.3 ± 5.6) ml; no operative deaths and severe complications occurred. All the cases were followed up for 6~24 months. On the six months after surgery: the scores GERD-Q and De Meester were significantly lower than those before the operation (P < 0.05), and the resting pressure of the lower esophageal sphincter was significantly higher than those before the operation (P < 0.05). During 1~2 years after the operation, the symptoms of 48 patients were completely disappeared, and 6 patients were improved significantly, 2 cases were invalid. The X-ray barium meal examination showed no recurrent esophageal hiatus hernia and digestive tract obstruction. Conclusions In the primary hospitals, the laparoscopic fundoplication and hiatal hernia repair for the gastroesophageal reflux disease with hiatal hernia is safe and effective, the clinical effect is satisfactory.